TPD claim declined

Should you suffer a workplace injury or illness, it can turn your world upside down. Still, Total and Permanent Disability (TPD) can be your veritable lifeline if you cannot go back to work in the same capacity as before. Making a TPD claim in the right time frame, whether you have TPD Insurance in super funds or with an insurer, can provide a lump sum payment to help you get back on your feet.

1300 679 222

TPD claims have a time limit so make sure yours is not declined by being lodged too late. You may need to check out a TPD helpline for more information. But a successful claim can cover medical, rehabilitation and other expenses you had to fork out for and any future care needs.

But what happens if you go through all the stress of claiming permanent disability in the hope of making a successful TPD claim only to have it rejected or declined by your insurer? Having a TPD claim declined can be devastating. But if this is you, don’t give up hope. If your claim has been rejected, it may not end since you may be able to take further action, which is worth fighting for, so call a TPD helpline.

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Why was my TPD claim rejected?

Unfortunately, claiming TPD benefits isn’t always a simple process since many claims are rejected by super funds and insurers who try to find ways of avoiding payouts. Typically, having a TPD claim declined by an insurer or super fund is not rare and can happen for any of the following reasons:

They don’t accept that you satisfy the definition of TPD.
They have medical evidence that you do not have an illness or injury.
They believe you did not meet the working requirements before the date of injury.
They believe you can work in some kind of employment.

And it also depends on the kind of insurance policy you have in place.

Were you provided with the right medical information and reports?

Having a TPD claim declined can happen if the provider was not given the right reports and medical information as to the reasons you have ceased work or if there was not sufficient detail in them that shows your case clearly. But your lawyer can request a review of the decision by your super fund or insurer to reject your claim.

1300 679 222

It’s crucial to avoid a claim being declined that enough of the right evidence is provided to the insurer to show why you have ceased work due to total and permanent disablement. For instance, specialist TPD lawyers may ask a doctor to give a more comprehensive medical report.

Often, more medical records are necessary during the claims process, including reports from multiple treating practitioners, tax returns, evidence of any mental illness, pharmaceutical benefit records etc., may be needed as evidence.

With TPD claims, your other previous disabilities, illnesses, or injuries may be relevant to your claim and should not be left out by anyone who has had TPD claims rejected.

Has the correct definition been applied in your claim?

The definition of TPD is different for every claim and every insurance and superannuation policy, but “total and permanent disability” usually means you’ve suffered an injury or illness that stops you from working in your regular job.

If you had your TPD claim declined, the correct TPD definition must be applied to your case. When determining whether you meet the TPD definition, factors other than the main reason for your inability to work must be taken into account.

For instance, if you had a bad shoulder but could still work despite the injury, and then you sustained a spinal injury that meant you couldn’t work, the insurer needs to know about it. A TPD lawyer can help you ensure important information such as this is included in your claim.

1300 679 222

What to do if your TPD Insurance claim is declined

Once you have a good grasp of the reasons behind your rejected claim for TPD, there are a number of things you can do to seek a review of your insurer or super fund’s decision. These may include the following steps:

Seek urgent legal advice.
Make a personal, written complaint to your insurer or superannuation provider.
Lodge an official complaint with your insurer or fund’s internal dispute resolution team.
Make a written complaint to the Financial Ombudsman Service.

Forcing the superannuation fund onto the negotiating table

Even though the insurer has declined your claim, you should consult a lawyer who may be able to request an internal review by the insurer’s or superannuation fund’s dispute resolution team. If your claim is declined, a lawyer can also refer the decision to the Australian Financial Complaints Authority (AFCA) or have your claim determined by a judge in Court and possibly have the decision overturned, so your TPD benefit is paid.

If your claim is declined, the right lawyers can also force the insurer or super fund onto the negotiating table and settle the matter out of Court. Many claims have been settled in the past “on the steps of the Court,” saving all concerned the costs of a long and expensive court battle.

Walking away with part of your benefit is better than nothing

If you have had your TPD claim declined, an out-of-court settlement may mean you receive less benefit than you had expected, but in many cases, it is better than walking away with nothing. Many TPD claims success stories have ended on the court steps at the very last minute with a successful settlement. Call the TPD helpline for more information today.

Get in touch

Let us know know about your requirements

Phone

1300 679 222

Email

info@tpdhelpline.com.au

TPD Helpline Australia can be contacted on 1300 679 222. Our helpline reps are well versed in all things related to TPD claims, injury compensation claims, health conditions, illnesses and injuries whether sustained at work or not. If there is an issue we can’t answer over the phone, we have access to a mountain of resources so that we can call you back within the day to provide answers.

Due to time differences across states, we recommend leaving a voicemail if your call is not answered. We promise to return your call within the day taking note of time differences. Our phone helpline is manned Monday to Friday, 8.30am – 5.00pm (AEST). Our Facebook social media page is manned 7 days a week and we respond to direct messages quickly. In fact, most of our enquiries come via Facebook private chat.